Stress-related cognitive and non-cognitive impairments in elderly patients

Aging is a physiological process that may develop long without manifestations of comorbidities. In the meantime a high proportion of elderly people very often experience limitations in daily life due to impairments in memory and other cognitive functions. Non-cognitive neuropsychiatric disorders, most commonly stress-related anxiety disorders, are a major contribution to maladaptation in these patients. The present studies of the neurobiology of aging enable one to decipher not only the mechanisms that underlie the physiology of brain aging, but also the factors that influence cognitive aging and aggravate the manifestations of cognitive dysfunction and neurodegenerative disease. The process of brain aging is known to presume the long-term preservation of functional neuroplasticity that is greatly influenced by different lifestyle factors, such as daily social and physical activities, the pattern and amount of food taken, cognitive activity, and stressful life events. These lifestyle factors are supposedly a potent tool to maintain physiological brain aging and a delayed cognitive diminution in elderly people. At the same time, studies of the possibility of pharmacologically correcting age-related (both cognitive and non-cognitive) impairments are promising to improve everyday function in elderly people

Novelty in the treatment of episodic tension-type headache

Frequent episodic tension-type headache (ETTH) is a serious medical problem that is primarily due to its high prevalence. Nonsteroidal anti-inflammatory drugs (NSAIDs) whose efficiency is determined by the rapid and complete regression of cephalgia are primarily used to relieve an ETTH attack. One of the ways to enhance the effect of NSAIDs is their combination with agents that accelerate their absorption or potentiate their action, with caffeine in particular; however, the use of combination agents is limited by a risk for drug-induced headache. A step on the road to the design of effective and safe analgesics has been the development of the combination drug Novigan that contains ibuprofen (400 mg) and the spasmolytics pitofenone (5 mg) and fenpiverinium (0.1 mg).Objective: to study the efficacy of Novigan versus ibuprofen 400 mg in relieving an ETTH attack.Subjects and methods. Fifty patients (mean age 37.1±10.9 years) with frequent ETTH that met the criteria of the International Classification of Headache Disorders, 2nd Edition, were examined. For relief of ETTH attacks, 30 patients used Novigan and 20 took ibuprofen in a dose of 400 mg.Results. There was a significant reduction in the intensity of cephalgia 49.9±35.8 and 68.2±45.9 min after drug administration in the Novigan and ibuprofen 400 mg groups, respectively (p = 0.007). The proportion of respondents was higher in the Novigan group (73.3%) than that in the ibuprofen 400 mg group (60%), which is close to the statistically significant difference (p = 0.085). The efficacy predictors were less pain intensity (p < 0.001) and a shorter time after onset (p < 0.001) in the ibuprofen 400 mg group at administration of the drug and only less pain intensity in the Novigan group at that moment (p = 0.07).Conclusion. Novigan is a combination analgesic that rapidly and effectively relieves an ETTH attack, including that of high intensity, as well as extended ETTH attack

Migraine and hypertension

Investigations of a relationship between migraine and hypertension are being continued. In spite of numerous studies, the association of some types of migraine (migraine with aura and migraine without aura) with hypertension has not been fully elucidated. This issue is particularly relevant since these forms differ both clinically and pathophysiologically. Of even greater importance are the analysis and prediction of associations between migraine and cardiovascular diseases (ischemic stroke, myocardial infarction, coronary heart disease). The review deals with the clinical and pathophysiological features of the relationship between hypertension and migraine. There is evidence for the anatomic and functional correlation between the antinociceptive system and blood pressure (BP) regulation control. It has been speculated that the increase in pain threshold is not the result of just hypertension as a disease, but it is caused by elevated BP-related hypalgesia. The efficacy of antihypertensive drugs is the fact that supports the association between hypertension and endothelial dysfunction. Identification of groups of patients having migraine and a high cardiovascular risk will allow timely early primary prevention and therapy. Introduction of a stratification approach at diagnostic stages may cause a reduction in cardiovascular morbidity and mortality rates

Criteria diagnostics of common types of primary headache according new changes in International Classification of Headache Disorders 3 beta, 2013

Headache Classification Subcommittee of the International Headache Society under supervision of Professor Jes Olesen (Denmark) created in 2013 new 3 beta version of International Classification of Headache Disorders. Present article summarized new criteria of diagnostics of common primary headache. It’s necessary to use these criteria for correct diagnostics of headache and their effective treatment.Классификационный комитет Международного общества головной боли во главе с профессором Есом Олесеном (Дания) разработал в 2013 году новую 3 бетта версию Международной классификации головных болей. В настоящей статье представлены новые критерии диагностики наиболее распространенных форм первичных головных болей. Необходимо использование зтих критериев для правильной диагностики головных болей и последующего эффективного лечения

Практические вопросы ведения пациентов с хронической мигренью. Рекомендации российских экспертов

The world medicine has achieved considerable advances over the last years in understanding of causes and pathogenesis as well as in specification of diagnostics criteria and studies of therapeutic approaches at chronic migraine (CM). Meantime this widespread disease is badly recognized by the physicians and diagnosed seldom. In addition, there is no generally accepted document, regulating the treatment of patients with CM, who are peculiar by their express deadaptation due to high frequency of severe attacks of the headache (HA), co-morbid psychic and somatic disorders, frequent abuse of analgetic drugs and low adherence to preventive therapy. The specialists of our country, like in other countries, gained their own unique expertise in management of such patients, who are hard to cure, including by botulinum A toxin – representative of the state-of-the-art generation of the registered drugs with the proven efficiency against CM. The article sets out the Recommendation from the Russian specialists as to management of the patients with CM, approved by the meeting of CM Expert Board (on November 12, 2014, Moscow), including with respect to time of treatment, rules of withdrawal and replacement of drugs and some other features, in compliance with modern world concepts on pathogenesis and treatment of such disease and expertise gained in managing patientswith CM in our country.последние годы достигнуты значительные успехи мировой медицины в понимании причин и механизмов развития, а также в уточнении диагностических критериев и изучении терапевтических подходов при хронической мигрени (ХМ). В то же время это широко распространенное заболевание плохо распознается врачами и редко диагностируется. Кроме того, отсутствует общепринятый документ, регламентирующий лечение пациентов с ХМ, отличающихся выраженной дезадаптацией вследствие высокой частоты тяжелых приступов головной боли (ГБ), коморбидных психических и соматических расстройств, частого злоупотребления обезболивающими лекарствами, а также низкой приверженностью к профилактической терапии. В нашей стране, как и в других странах, специалистами накоплен собственный уникальный опыт по лечению таких труднокурабельных пациентов, в том числе ботулиническим токсином типа А – представителем новейшего поколения зарегистрированных лекарственных средств с доказанной эффективностью при ХМ. В статье представлены Рекомендации российских специалистов по ведению пациентов с ХМ, согласованные на Совете экспертов по ХМ (12 ноября 2014 г., Москва), в том числе по срокам лечения, правилам отмены и замены лекарственных препаратов и некоторым другим особенностям, в соответствии с современными мировыми представлениями о патогенезе и лечении данного заболевания, а также накопленным опытом по ведению пациентов с ХМ в нашей стране

Placebo analgesia

Placebos are drugs, devices, or other treatments that are physically and pharmacologically inert. The placebo effects are therapeutic responses to the context of the treatment process. They are mediated by factors, such as training of a patient, his/her expectations associated with treatment, as well as social conditions, the features of cognitive functioning, etc. and can affect the clinical and physiological responses caused by the health status. The analgesic effects of placebo in different types of pain syndromes reach 25–80%. The formation of placebo analgesia involves the brain structures that belong to the pain matrix and are implicated in the basic processes of perception, in the mechanisms of pain modulation, and in a number of other cognitive and affective processes, as well as in the emotional reactions not caused by pain. A deeper understanding of the mechanisms of action of placebo analgesia can optimize the strategy of current pain therapy

MIGRAINE-ASSOCIATED CEREBROVASCULAR DISORDERS

Migraines and cerebrovascular diseases are comorbid disorders that are widespread in the population. The close relationship between these states is demonstrated by epidemiological, clinical studies, as well as by pilot studies of their pathophysiology. Patients with migraines have a clear increase in the risk of ischemic stroke, especially when there are risk factors such as female sex, presence of aura symptoms, smoking, hormonal contraceptive use and high incidence of migraines. Despite the abundance of migraine studies, no strategies have been developed to modify her treatment for patients with attendant pathology so far. In the meantime, some studies have convincingly demonstrated the advantages of some therapeutic approaches, which could be used to optimize management of these patients with these frequently co-existing disorders

Current concept of the pathophysiology of migraine and new targets for its therapy

Migraine is a common chronic neurological disease. Many neurogenic, vascular, autonomic, and other mechanisms at different levels of the central and peripheral nervous systems are assumed to be implicated in the pathophysiology of headache and other manifestations of migraine. Advances in understanding the neurobiology of migraine have made it possible to clarify the main patterns of neurogenic-vascular relationships that explain the leading clinical manifestations of migraine, as well as to identify some biological markers that have triggered the creation of new targeted therapies for the disease. This review is dedicated to the latest advances in studying the pathophysiology of migraine and to new pharmacological approaches to its treatment